Aim: The laser methods and electro-surgical
processes used in medical treatment have
intensified exposure to pyrolysis products
(surgical smoke). Surgical smoke is a mixture
of innumerable gases and vapours, liquids
and solids with a variety of hazardous local,
systemic, reversible and irreversible effects.
The thermal decomposition of tissue also results
in intensive odour development. It has
furthermore been demonstrated that surgical
smoke can contain biologically active
constituents (cells, cell residues, viruses etc.).
The composition of the smoke and intensity
of its production depends on the method
of treatment selected and on the tissue to be
treated and can fluctuate greatly because of
the multifarious influencing factors. For this
reason, the German BGW, the Swiss Suva and
the French INRS have undertaken a systematic
evaluation of the hazards involved and
issued joint recommendations for protective
measures.
Methods: The working techniques, the variables
influencing smoke development and
the exposure to which employees are subject
were determined on the basis of a comprehensive
literature research. The institutions
involved formed an expert panel to sort and
evaluate the exposure information found and
joint recommendations were compiled for
the protective measures required for activities
which involve regular exposure to surgical
smoke.
Results: The exposure of persons working
in operating theatres, when expressed for
individual substances, lies well below the individual
limit values existing for workplaces.
However, a mixture of pyrolysis products can
only be assessed with a view to minimizing
exposure, as many constituents have carcinogenic,
mutagenic or teratogenic properties
and there is no threshold value for airborne
exposures to the vast majority of substances
in inhaled smoke.
Conclusions: The recommendations put forward
by the work group were summarized in
a consensus paper of the International Social
Security Association (ISSA). They contain an
evaluation of the hazard posed by surgical
smoke and depict suitable technical, organizational
and personal protective measures.
They will be available on the Internet at www.
issa.int.
